Improving communication among health professionals through education: a pilot study

Communication can be thought of as a message that is sent, received, and understood. Each discipline of the health profession has its own jargon and means of expressing ideas in shorthand. These separate forms of communicating are effective among those of the same background but are often at the root of misunderstandings between professional groups. This article reviews communication theory and traces the difficulties created when inter-disciplinary teams of healthcare try to work together and communicate. As multi-disciplinary teams are increasingly dealing with the complex problems of today's healthcare system, clear communication and understanding has never been more important. If educators could assist in creating an understanding of vocabulary used for decision processes, communication could improve. The authors of this study performed a multi-stage Delphi survey that grouped terms used by administrators and clinicians and produced a lexicon of corresponding terms. An expert panel then reviewed and modified the list. The result is a lexicon that can be useful to assist clinicians and administrators to communicate with each other. By utilizing clinical terminology, or vice versa, instead of management or clinical jargon, some of the translation done by administration or clinicians could be reduced. Examples of how the lexicon can be utilized are provided in the article. This includes using it in health administration education to demonstrate the variances in clinical/managerial terms. It could also be provided as a primer to physicians, nurses, and other health professionals who assume administrative positions to enhance their communication with administrators.     

环孢霉素A滴眼预防高危角膜移植免疫排斥的效果

目标 探讨环孢霉素Ａ（ＣｓＡ）联合地塞米松局部滴眼预防高危穿透角膜移植（ＰＫＰ）免疫排斥反应的效果。方法 将７７眼高危ＰＫＰ分为ＣｓＡ组（３７眼）;２％ＣｓＡ蓖麻油溶液联合地塞米松滴眼;对照组（４０眼）单独使用地塞米松滴眼。采用生存曲线进行比较。结果 术后２年,两组植片存活率分别为８９％和６０％,差异有显著性（Ｐ〈０．０５）。结论 ２％ＣｓＡ蓖麻油溶液联合地塞米松溶液局部滴眼是预防高危ＰＫＰ免疫排     

Economic grand rounds: a forum for cost consciousness

This article analyzes the implementation of a traditional Economic Grand Rounds (EGR) program in a teaching hospital. The conclusions are that the original concepts of EGR--presentations of treatment costs by clinicians in a grand rounds setting, reinforcement of agreed changes in practice patterns, and subsequent evaluation and participation--are still valid but are inadequate to ensure a successful program. Other factors must be added if EGR is to attain its goals. These factors are administrative and nursing involvement, a provision to make policy changes, and incentives for the medical staff. This article also outlines areas of potential savings achieved through an EGR program in laboratory testing, preoperative laboratory testing, and intravenous therapy with antibiotics.     

Side effects during continuous epidural infusion of morphine and fentanyl

Respiratory effects, nausea, somnolence, and pruritus were compared during a 48-hr period of continuous epidural morphine (n = 34) and fentanyl (n = 32) infusion in 66 patients following elective total replacement of the hip or knee joint. Respiratory effects were assessed by PaCO2. Side effects were assessed by visual analogue scale and considered to be present when the score was above 30. Assessment was made at preoperative visits then 3, 6, 12, 24, 36, and 48 hr after the epidural injection. The bolus dose and subsequent infusion rate were 3,900 +/- 1,300 micrograms and 427 +/- 213 micrograms.hr-1 for morphine, and 85 +/- 46 micrograms and 56 +/- 27 micrograms.hr-1 for fentanyl. Pain relief was similar in both groups. In the morphine group, PaCO2 elevation and nausea occurred over a period of more than 12 hr (P less than 0.05). In the fentanyl group, there was no PaCO2 change, and nausea was confined to the first few hours. Nausea was more severe (P less than 0.01 at six hours and more frequent (24 hr cumulative incidence, 53 vs 28%, P less than 0.05) in the morphine group. Somnolence was prominent within several hours in two-thirds of patients in both groups. Somnolence continued to decline thereafter in the morphine group, but it was demonstrable in approximately half of the patients throughout the second day in the fentanyl group. The incidence was higher in the fentanyl group at the 48th hr (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

高频电波刀行电圈切除治疗宫颈病变的临床应用探讨

目的　评价高频电波刀行电圈切除 (LEEP)治疗宫颈病变中的临床应用价值。方法　回顾性分析我院 2 71例LEEP治疗宫颈病变的临床资料 ,所有病例均行阴道镜下多点活检和LEEP术后病理诊断 ,在炎症和赘生物病变外缘 3mm进出电极 ,对于CINI与HPV感染患者 ,电极在病变边缘外 5mm进出。结果　阴道镜下多点活检与LEEP术标本的病理诊断差别有显著性 (P <0 0 5 )。 2 71例患者术后随访 2 4 3例 ,术后复查宫颈细胞学 ,仅 9 0 5 %出现细胞核肥大和核异质。结论　LEEP对包括炎症、损伤、癌前病变、HPV感染等宫颈病变是一种非常理想的诊断、治疗手段。宫颈细胞学检查、阴道镜下多点活检、LEEP术后病理诊断构成了宫颈病变系统的诊断模式。LEEP可以广泛地应用于治疗CIN各级病变 (原位癌除外 ) ,LEEP也适用于CINI的治疗 ,LEEP治疗的范围可以在病变边缘外 5mm处进出电极     

HBV-YMDD变异患者与中医虚实辨证关系初探

目的 :初步探讨服用拉米夫定后HBV -YMDD变异患者中医辨证虚证、实证之间的关系。方法 :对服用拉米夫定半年以上的乙型慢性病毒性肝炎患者采用联合基因集团上海博华基因技术有限公司出品的迈科锐乙型肝炎病毒突变检测基因芯片 ,进行HBV -YMDD变异检测。出现HBV -YMDD者 ,根据中医基础理论 ,将其分为实证、虚证 ,来探讨HBV -YMDD变异患者中医虚、实辨证的关系。结果 :HBV -YMDD变异患者中实证变异率(38/ 4 8)明显高于虚证 (10 / 4 8) ,具有统计学意义。结论 :HBV -YMDD变异与虚、实辨证之间具有相关性。     

pH-敏感甲硝唑壳聚糖-聚乙烯吡咯烷酮水凝胶的研究

 目的 制备pH-敏感的壳聚糖-聚乙烯吡咯烷酮（PVP）水凝胶，作为甲硝唑治疗胃溃疡控释给药系统的载体。方法 用戊二醛交联适宜比例混合的壳聚糖、PVP混合物，负载甲硝唑或不负载甲硝唑，制备载药水凝胶及空白水凝胶，再冷冻干燥形成半渗透聚合网状物Semi-IPN。用扫描电镜观察性状结构，用测角仪测定其辛烷接触角，用电子天平测其在不同pH介质中的膨胀率，用红外测定了其特征峰，同时考察了载药水凝胶体外释药特性，初步药理实验判断其对实验性胃溃疡的疗效。结果 水凝胶具多孔性，且可很好地负载甲硝唑。辛烷接触角为(143.8±1.02)°，显示本品有较大的亲水性。膨胀率随pH的降低而增大，红外图谱说明水凝胶在酸性介质中膨胀时有-NH₂质子化。甲硝唑在酸性介质中的释放也随pH降低而增大，在pH 1.0介质中，3 h达最大释放量87%。初步药理实验表明，与对照组及甲硝唑片治疗组相比，该甲硝唑水凝胶对胃溃疡具有较优的治疗作用（P分别<0.01及P<0.05）。结论 甲硝唑水凝胶具有pH-敏感膨胀性，可改善甲硝唑对实验性胃溃疡的治疗作用，可作为治疗胃溃疡的新型胃部控释系统研究开发。     

肿瘤坏死因子-β抗肿瘤及作用机制的研究

目的 :探讨肿瘤坏死因子 -β(tu mornecrosisfactor β ,TNF β)对 3种人癌细胞的增殖抑制作用及其细胞分子机制。方法 :采用多种体外及体内实验方法 ,从多侧面证实TNF β的抗肿瘤作用。并采用细胞内游离钙浓度测定、12 5I cAMP放免检测法检测cAMP含量。结果 :不同浓度TNF β对肿瘤细胞系均有增殖抑制作用 ,且呈剂量依赖性。当TNF β与顺铂和多柔比星合用 ,JF3 0 5细胞死亡百分比分别达到 ( 68 6±9 0 ) %和 ( 76 5± 7 9) %。TNF β实验组细胞内cAMP浓度明显增加 ,JF3 0 5细胞由( 0 0 5 72± 0 0 176)上升到 ( 0 2 896±0 0 784) pmol/10 6个细胞。此外细胞内钙浓度上升并且凋亡。结论 :TNF β具有体内、外抗肿瘤作用 ,其部分机制是通过增加cAMP含量及诱导细胞凋亡     

胃肠造瘘术在全梗阻型食管癌放疗中的应用

目的　评价胃肠造瘘术在全梗阻型食管癌放疗中的临床应用价值。方法　 98例全梗阻食管癌放疗病人 ,5 3例于疗前及疗中行胃肠造瘘术 ,其中照射剂量DT>5 0Gy为 2 7例 ,余 2 6例放疗剂量DT<5 0Gy ;45例于疗中仅予输液支持以维持放疗。结果　行胃肠造瘘术组kanofsky评分较对照组明显提高 ,体重亦维持或增加明显 ,两者比较P <0 0 0 5 ;胃肠造瘘术组与对照组其 1年及 3年生存率分别为 :33 9%、2 8 8%和 15 0 %、4 4% ,两组间生存率差异有显著性意义 ( χ2 =7 2 5 ,P =0 0 0 71) ;胃肠造瘘术组中放疗DT>5 0Gy与DT<5 0Gy病人其 1年及 3年生存率分别为 :48 1%、19 2 %及 2 2 2 %、7 7% ,两组间生存率统计学有显著差异 ( χ2 =4 2 0 ,P =0 0 40 4)。结论　全梗阻型食管癌疗前或疗中行胃肠造瘘术 ,可在改善病人体质状况、维持或增加体重基础上 ,明显提高患者 1年及3年的生存率 ,且放疗剂量DT 应 >5 0Gy。